1) What state are you in?
2) Is malpractice insurance available to you?
3) Do you carry it? Why/why not?
4) How much does it cost?

(feel free to answer as few questions as you want, I know they are personal)

I feel so dumb, but I just found out that the homebirth midwives in my state basically don't carry malpractice insurance because it costs $30,000 a year. : This seriously dampens my dreams of becoming a midwife because I simply can't envision practicing without it. While I understand carefully choosing your clients and being diligent in your care, people do sometimes sue midwives, and god forbid, I could make a mistake where they had the right to do so. In such case they could go after everything we have, and truly I don't care about my money so much as I worry about things like our kids' college funds.

If I get sued and I lose, they'll take everything I have. That's a risk I'm willing to take, and I guard against it by being the best damn midwife I can be. From what I've seen, it's a bigger risk to carry malpractice insurance. Deep pockets attract lawsuits.

I worked with a midwife who got sued. She did nothing wrong - she wasn't even the client's midwife when the baby was born. The client had transferred care a month prior and the midwife was only present as her doula. The midwife's name got thrown in the lawsuit solely because the family's attorney assumed she had malpractice insurance that would take care of it and no harm would come to her because of it. When they found out she didn't they dropped her from the suit like a hot potato.

Frankly, if we look at the state of obstetrics in our country right now the main reason it sucks so bad is because of malpractice insurance.

My relationship with my clients far exceeds anything that doctors have with their clients. By offering my clients a CHOICE in their care and births there is a much, much smaller chance of ever being sued.

If you feel like you need malpractice insurance, being a CNM in a hospital might be a better option.

I think that malpractice protocols totally screw women and families.

There are ways to incorporate your practice so any lawsuit doesn't affect your personal financial assets. Talking to a lawyer and/or financial planner about this might be helpful.

I can't imagine practicing in a state of fear that I might get sued. It definitely would make me a very, very different midwife than I am now, resulting in huge restrictions on the choices my clients could make.

I agree with everything you are both saying in theory, and I suspected these were the kinds of responses I would get.

I feel like there is a huge difference between "living in fear of being sued" and not wanting to have all of my family's personal assets vulnerable. I certainly intend to do my very best as a midwife at every birth. I also feel like I can develop a trust in my clients. But the reality is, sometimes things go wrong, and sometimes people get sued. I think there is a difference in acknowledging that reality and preparing accordingly vs. fearing that outcome. I also don't think purchasing that insurance is inviting that to happen.

My worry is not frivilous suits for no reason. My worry is that I actually make a mistake, god forbid, and someone's baby is harmed. I feel those parents have a right to financial reparations and it should come from somewhere. Is this where we disagree? Are you so confident in your abilities that you don't think this is ever a potential to happen? I guess I don't believe it. We are all humans, even midwives. And all humans make mistakes sometimes.

I have a million philosophical reasons why I would not want to be a CNM in a hospital or set foot in nursing school.

As far as protecting your personal assets through incorporation, this is largely a myth...from speaking to my husband who is a financial planner, these corporations are easily pierced in a lawsuit, especially if they can prove that you set up the corporation solely to protect your personal assets. And especially if it's something as emotional as a baby or mother being harmed.

I certainly agree that one of our hugest problems right now is malpractice and the way it is set up. But the reality is that is the system we have in place. I don't feel like protesting that by hanging my children's future on the line.

I feel sad that my viewpoint is so different than others, and that by holding this viewpoint I seem to offend the philosophies of others. It seems that by feeling somewhat practical and objective about the issues, and really acknowledging the small "what ifs", it implies that I don't trust women and that I offend the sensibilities of independent midwives. But I just can't get comfortable leaving everything my husband and I have worked for to provide for our kids completely vulnerable.

nashvillemidwife: what happened to the midwife whose care this woman had transferred to? Or did she transfer to a hospital birth?

1) Washington State
2) Malpractice Insurance is available and required if you charge for midwifery care/insurance companies are required to pay for midwives and they require coverage
3) I don't have it b/c I'm not licensed yet.
4) It varies depending on the number of births- less than $15K, but more than 10K per year, payable quarterly.

My brother's baby had a birth injury (FYI not caused by a midwife) and the child's lifetime care costs were $millions. When faced will bills like that, many people would look to any sources available to them, including the insurance carried by their care provider. I think tort reform + no-fault insurance pools + arbitration + universal healthcare will help the situation. If my (hypothetical) injured child's home health aide + hospitalizations + education were covered, I wouldn't need to worry about where the money to cover those things would come from (and try to get what I need + enough to give a lawyer 1/3 of it).

Yes, because I want to legally advertise, charge for care, and have contracts with insurance companies.
It means that I need to get a certain number of clients pretty quickly or I'll go broke. It's a bad system in that newly licensed midwives can end up taking clients that they aren't a good match for in order to have clients.

Are you so confident in your abilities that you don't think this is ever a potential to happen?

No, I just choose not to live in fear of it. I do everything I can to be the best midwife I can, to worry about the rest doesn't serve anyone. This is where you think malpractice insurance can make up for the rest. I don't. I do firmly believe it invites lawsuits.

I feel sad that my viewpoint is so different than others, and that by holding this viewpoint I seem to offend the philosophies of others. It seems that by feeling somewhat practical and objective about the issues, and really acknowledging the small "what ifs", it implies that I don't trust women and that I offend the sensibilities of independent midwives. But I just can't get comfortable leaving everything my husband and I have worked for to provide for our kids completely vulnerable.

I feel the exact same way. I started a thread asking about malpractice insurance a little while ago and got hardly any responses, and I find it so sad and disheartening to be on the other side of issues like these. It has been my unfortunate experience to learn that anyone will sue, and if there is enough pain involved, could try to take everything you have. It does not have to be a case of negligence, just any bad outcome. And to make things more complicated, in order to be licensed here, you must have a doctor backup, but no one wants to cover a midwife with no malpractice. And I don't blame them for not wanting to put their careers on the line for me and my handful of clients. So basicly, I have spent a huge amount of time and money to attend a meac accredited school, so that I can be licensed only to feel that my hands are tied now that I'm almost a midwife. It is very frustrating and emotional. Sorry for the rant...

Wife to Joe and Mama to Rosie, 6/28/06, Jack, 10/25/08 and JoJo 3/18/10.

nashvillemidwife: what happened to the midwife whose care this woman had transferred to? Or did she transfer to a hospital birth?

It was a hospital birth. Doctor, hospital, and midwife (who was only there as a doula) were named in the suit. It was a birth injury case so in no way related to the prenatal care she received from the midwife, just her very presence there got her named because the attorney assumed there was money in it. She was dropped as soon as they found out she didn't have insurance. I don't know what happened after that.

My sensibilities are not offended by midwives who carry malpractice insurance. I understand your feelings; it's possible to understand and sympathize with someone while being in disagreement. I'm sorry that you feel alienated.

Hmmmm. I didn't think it was opinion that carrying insurance opens a birth worker up to a higher probability of lawsuit. I was pretty sure I saw a study to that effect, when I was certifying to be a doula... *shuffles off to see if she can find said study*

Offended sensibilities was probably a poor choice of words, I apologize for that.

I was mostly feeling alienated by comments that imply by even wanting the option of malpractice insurance that one would be "practicing in a state of fear" or better suited for hospital work as a CNM. Quite honestly, I would rather not be a midwife at all than work as a CNM because I disagree so much with that model of care, and I don't think not wanting to risk my family's livelihood should make me unsuitable for licensed midwifery. I also don't think that by wanting some financial protection, it automatically assumes that I am in a "state of fear". We purchase all kinds of insurance for the what ifs in life...I carry health insurance for myself and my family not because I live in fear of getting cancer, but because if I did, I don't want to be bankrupted by it. Same with life insurance. I'm not afraid of my husband dying, but I certainly feel better having a plan for if he did.

I don't disagree that carrying insurance invites lawsuits, and I wouldn't be surprised if courtenay_e can produce such a study (though I don't remember saying that was just an opinion either...not sure where that's coming from). But at least even in those cases, with the insurance I would be protected, whereas it would only take ONE lawsuit to ruin me without it.

A lot of attention is given to trusting clients and I suppose I'm just not quite there and maybe on the cynical end. As olive& pointed out, when things go wrong and people are hurting as badly as they are when a baby is harmed or lost, in this culture, people tend to sue. You don't have to look any further than this board to see that. I also have seen a lot of posts from mothers on MDC about either having lied to or planning on lying to their midwives. In addition, there is the fact that many clients end up not paying. It's hard for this to inspire the wholehearted trust it would take for me to feel ok putting not just mine buy my children's future on the line. Midwifery is a demanding field for families anyway, I can't imagine missing 3 Christmas mornings in a row and then losing their college savings too.

I also don't understand how trusting clients is reconciled with the idea (fact?) that more of them tend to sue if you have insurance. If you trust that they won't sue because of a relationship you've established, why should that change if you have insurance? I ask that not adversarily, but truly...do you think the relationship you have changes just by holding insurance? Do you feel like your clients trust you MORE not having it? Because I have to say, I didn't even realize that my midwife didn't have it last time, and now knowing that she doesn't, really doesn't change much of how I feel about her or her care.

I certainly understand and mostly agree with the opposing viewpoint. Trust me, I wish the system were different, because it does tear me up that insurance ties hands the way it does. I just don't feel like malpractice insurance is so bad and the antithesis of true midwifery care that potential midwives who want to have it are not really suited for independent midwifery. I don't think you do either, nashvillemidwife, but some midwives clearly do and it makes me sad just because I feel like we're in the same boat essentially and I would think we could understand each other more.

Quite honestly, I would rather not be a midwife at all than work as a CNM because I disagree so much with that model of care

I'm not really sure what you're talking about here. The midwifery model of care is what it is. Some midwives adhere more strongly to it than others. Some of those that don't are CNMs and some are other midwives. CNMs do not follow a different model of care, though they are more likely to work in a restrictive environment and be confined to protocols and policies that violate that model of care. Please don't be so general about an entire credential. There are CNMs who don't practice in hospitals, who strictly adhere to the midwifery model of care, and who practice without malpractice insurance.

I'm sorry, I would rather not be a CNM in a hospital, or follow that path of education than not be a midwife at all. The hospital policies and procedures that most CNMs have to adhere to DO violate the midwifery model of care in certain aspects, as you said. That doesn't mean I don't have utmost respect for CNMs. I adore the ones I've worked with as a client and as a doula (a CNM caught my first baby), but that doesn't mean I agree with or would be able to practice within those restrictions, and I think oftentimes those restrictions hurt mothers and babies. However I think their role in our system is incredibly important, and didn't mean to badmouth the credential AT ALL.

I feel like I'm getting tangled up in semantics. I don't disrespect CNMs and I certainly feel like they are truly midwives. I *loathe* the term "medwife". I didn't intend to paint my opinion of CNMs with that brush, at all. I just don't feel like that path is right for me, at all. And this comes from someone who has spent years making this decision and even started nursing school at one point.

It's hard for this to inspire the wholehearted trust it would take for me to feel ok putting not just mine buy my children's future on the line. Midwifery is a demanding field for families anyway, I can't imagine missing 3 Christmas mornings in a row and then losing their college savings too.

I also don't understand how trusting clients is reconciled with the idea (fact?) that more of them tend to sue if you have insurance. If you trust that they won't sue because of a relationship you've established, why should that change if you have insurance? I ask that not adversarily, but truly...do you think the relationship you have changes just by holding insurance?

If you want to be a midwife, you might have to put their financial future on the line anyway. Lawsuits are rare for homebirth midwives and big judgements even rarer, but most malpractice insurance policies have caps -- some of them have caps that are pretty low. When the practice I worked for was asked to get malpractice insurance by our landlord, we looked into it and found that the only policy available to us was for $250000 per occurance. The premium for that was $20,000 per year. I know that there are cheaper, better policies available in other states, but even the usual $1milliion policy wouldn't cover every possible judgement against you. A judge could find a bigger settlement.

The reason why clients might be more likely to sue if you carry malpractice is that they will feel that they aren't hurting you as much personally. Also, if someone else is sued related to a birth that you are part of, the likelihood of your being named a co-defendant is higher if you have malpractice.

For me, it boils down to value -- a policy that costs thousands of dollars per year to protect my almost non-existent assets against a lawsuit is not a good value. I'd rather stick all of that money in a ROTH IRA and call it a "legal defense fund" and use it to retire to a little beach shack in Belize after my midwifery career is over than to give it to the insurance co.. Insurance companies are for-profit entities, in general. If they don't take in more than they pay out, then they would cease to exist. I understand their worth, but for me and my individual situation, the math doesn't work out.

Stacia -- intrepid mama, midwife, and doula. Changing the world one 'zine at a time.

This, to me, is a huge liability as a midwife. I am concerned with protecting my clients' choices to birth how they want. Malpractice insurance severely handicaps that ability to offer birthing freedom.

I think Stacia's idea of investments is much easier to deal with ethically for me than standard malpractice insurance.

I practiced as a CNM in a hospital setting (two different practices--only about 18 months in each). I worked for a private practice (physician owned) for one job, and I worked in a hospital based clinic (hospital owned; the physicians were also employees) for the other job. In both jobs, my malpractice insurance was covered as part of my benefits package.

When I left both jobs, I chose not to purchase tail coverage (mainly because of cost). Because of the statute of limitation on birth injuries, I could still be held liable for problems that arose during my practice. I have to choose not to think about it, honestly.

Oh, I'm in Georgia. The first year you are practicing, the cost was about $4000/year, going up to about $10,000/year after 5 years.

OP--you say that people are talking about trust between themselves and their clients, but I don't think it's exactly trust that is being talked about. It's that if a woman feels empowered, makes a large number of the decisions with full honest-to-god informed consent that she is more likely to own the outcome, whatever it may be. It's not that she trusts the midwife, it's that she has trusted herself.

AmieV, did you read Baby Catcher? I did, and it certainly didn't make me feel very good about malpractice insurance.

I feel that carrying malpractice is like painting a big red bullseye on yourself. A client who would never dream of suing you out of house and home could be convinced that malpractice insurance means a lawsuit won't hurt you personally.

In Florida, the licensed midwives must have malpractice insurance. It is extremely expensive. That whole deal is one of the reasons I don't want to practice in Florida.

"If you only knew how many things I want to say and don't, you'd give me some credit."

In Florida the cost of insurance depends on which county you are in. I'm in Alachua County and my insurance is $2200 for the next year. That is for 1-12 births. for each birth after that I think you add $120 or something like that.

I hate paying that but we are required. And compared to insurance elsewhere and other professions, it's not that much. I heard someone mention that insurance would cost them $30,000. I'll be lucky if I make that much money in a year.

People who choose home births and midwives are more cogniscent of the fact that birth is unpredictable and has its own risks; therefore, I would assume that most, not all of these people would not be likely to sue.

That was true of me as a homebirth mother 4x and client of the midwife I felt comfortable with.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."

For me, it boils down to value -- a policy that costs thousands of dollars per year to protect my almost non-existent assets against a lawsuit is not a good value. I'd rather stick all of that money in a ROTH IRA and call it a "legal defense fund" and use it to retire to a little beach shack in Belize after my midwifery career is over than to give it to the insurance co.. Insurance companies are for-profit entities, in general. If they don't take in more than they pay out, then they would cease to exist. I understand their worth, but for me and my individual situation, the math doesn't work out.

: not a midwife here, but being in a similar postion, thinking ahead at all involved in starting a practice, i have to say i agree with this statement.

Quote:

from pamamidwife
I must re-iterate that my biggest issue with malpractice insurance is the extremely conservative protocols that will likely risk out so many of my clients.